In order for the meditation practice to take root in your life and flourish, you will have to know why you are practicing. How else will you be able to sustain non-doing in a world where only doing seems to count? What will get you up early in the morning to sit, taking up residency in the present moment in awareness, perhaps simply by befriending your breathing for a time, when everybody else is snug in bed? What will motivate you to practice when the wheels of the doing world are turning, your obligations and responsibilities are beckoning, and a part of you decides or remembers to take some time for “just being”? What will motivate you to bring moment-to-moment awareness into your daily life? What will prevent your practice from losing energy and becoming stale or from petering out altogether after an initial burst of enthusiasm?
To sustain your commitment and keep your meditation practice fresh over a period of months, years, and decades, it is important to develop your own personal vision that can guide you in your efforts and remind you at critical times of the value of charting such an unusual course in your life. There may be times when your vision will be the only support you have in keeping up your practice.
In part, that vision will be molded by your unique life circumstances, by your personal beliefs and values. Another part will develop from your experience of the meditation practice itself, from letting everything become your teacher: your body, your attitudes, your mind, your pain, your joy, other people, your mistakes, your failures, your successes, nature—in short, all your moments. If you are cultivating mindfulness in your life, there is not one thing that you do or experience that cannot teach you about yourself by mirroring back to you the reflections of your own mind and body.
Still another element of your vision will have to come from your embeddedness in the world and from your beliefs about where and how you fit into it. If your health is a major part of your motivation for coming to meditation practice, then your knowledge of and respect for your body and how it works, your perspective on what medicine can and cannot do for you, and your understanding of the role of the mind in health and healing may contribute important elements to your vision. The strength of your personal vision will depend in great measure on what you know in these areas and on how much you are willing to learn. As with the meditation practice itself, this kind of learning requires a lifelong commitment to continual inquiry and a willingness to modify your perspective as you acquire new knowledge and arrive at new levels of understanding and insight.
In MBSR, we try to inspire people to learn more about their own bodies and about the role of the mind in health and illness as a fundamental element of their ongoing adventure in learning, growing, and healing. We do this by touching on the ways in which new scientific research and thinking are transforming the practice of medicine itself, and by exploring the direct relevance of these new developments to our lives as individuals and to the meditation practice. This is now made infinitely easier by Internet searches you can do yourself periodically, if you care to keep up with the latest findings.
The Stress Reduction Clinic and MBSR do not exist in a vacuum. The clinic took shape originally in 1979, under the aegis of the Department of Ambulatory Care at the University of Massachusetts Medical Center’s hospital. It was soon given an academic home within the Department of Medicine, and then, a few years later, within its newly formed Division of Preventive and Behavioral Medicine. At that time, behavioral medicine represented a new current within medicine itself, one that contributed to a rapid expansion of our ideas and knowledge about health and illness. New research findings and new ways of thinking about health and illness from this perspective, and later, through the lens of what later became known as integrative medicine, gave rise over time to a more comprehensive perspective within medicine itself, one that recognizes the fundamental unity of mind and body, and how essential it is for people to be active participants, whenever possible, in their own health care—by learning more about health in general and how to maintain and optimize it through their own efforts—in close collaboration with their doctors and the rest of the health care team. As we have already seen, this perspective has come to be called participatory medicine. It is based on the view that all of us, by virtue of being alive, have deep interior resources for learning, growing, healing, and transformation that can be tapped, nurtured, and mobilized in the service of living a fuller and more optimal life on every level: from the most basic molecular and cellular levels (our genes, chromosomes, and cells) to higher levels of organization of the body (our tissues, organs, and organ systems, including the brain and the nervous system), to the psychological level (the domain of our thoughts and emotions), to the level of the interpersonal (the domain of the social and cultural, including our relationships with others, with society as a whole, and, of course, with the environment—the natural world of which we are an intimate part).
This new lens of a more participatory medicine recognizes and emphasizes the importance of people learning to communicate more effectively with their doctors in order to ensure that they understand as much as they want to about what their doctor is telling them about their condition and possible treatment options. It also emphasizes the importance for patients to be seen, met, and understood by their doctors, and to know that their needs will be acknowledged, taken seriously, and whenever possible, honored.*
Perhaps the most fundamental development in medicine over the past decades is the recognition that we can no longer think about health as being solely a characteristic of the body or the mind, because body and mind are not two separate domains—they are intimately interconnected and completely integrated. The new perspective acknowledges the central importance of thinking in terms of wholeness and interconnectedness and the need to pay attention to the interactions of mind, body, and behavior in any comprehensive effort to understand and treat illness. This view emphasizes that science will never be able fully to describe a complex dynamical process such as health, or even a relatively simple chronic disease, without looking at the functioning of the whole organism, rather than restricting itself solely to an analysis of parts and components, no matter how important that domain may be as well.
Medicine is presently expanding its own working model of what health and illness are and how lifestyle, patterns of thinking and feeling, relationships, and environmental factors all interact to influence health. The new model explicitly rejects the view that mind and body are fundamentally and inexorably separate. In its place, medicine is presently seeking to articulate an alternative, more encompassing vision for understanding what we actually mean by “mind” and “body,” and by “health” and “disease.”
This transformation in medicine is sometimes referred to as a paradigm shift, a movement from one entire worldview to another. There is little doubt that not only medicine but all of science is going through such a shift as the implications of the revolutionary changes in our understanding of nature and of ourselves that have come about in the twentieth and twenty-first centuries become clearer. For the most part, our day-to-day thinking about physical reality—our tacit assumptions about the world, the body, matter, and energy—is based on an outmoded view of reality, one that has changed little in the past three hundred years. Science is now searching for more comprehensive models that are truer to our understanding of the interconnectedness of space and time, matter and energy, mind and body, even consciousness and the universe, and what role the human brain, by far the most complex, interconnected, specialized, and ever-changing organization of matter in the known-by-us universe, plays in all of it.
In this section, you will encounter some of these new ways of looking at the world based on the principles of wholeness and interconnectedness, as well as their implications for medicine, health care, and your own life. We will follow two major threads, both of which are intimately related to the practice of mindfulness, and to each other. The first has to do with the whole process of paying attention. In the next chapter we will take a closer look at how we see things (or don’t see things) and how we think about them and represent them to ourselves. This has direct bearing on how we conceptualize our problems and on our ability to face, understand, cope with, and possibly befriend and transcend some of the most rending and toxic effects of stress and illness. We will explore what we mean by wholeness and interconnectedness and why they are so important for health and healing. We return to this theme in the last chapter in this section.
The second thread we will follow has to do with the new perspective that is developing based on research in behavioral and integrative medicine, health psychology, and neuroscience. It addresses the question of how the mind and body interact to influence health and illness, what the implications of this new understanding are for health care, and what we mean when we speak of “health” and “healing” in the first place.
Taken together, these two threads may help you to expand your perspective on the meditation practice and the value of cultivating greater mindfulness in your own life. They underscore the importance of paying attention both to personal experience and to current developments in medical research if you hope to enhance and optimize your own health.
However, if the information and the perspective presented in this section are only assimilated by your thinking mind, they will be of little practical value. This section and the following one on stress are meant to encourage a growing interest in, respect for, and appreciation of the exquisite beauty and complexity of your own body and its remarkable ability to self-regulate and heal at every level. The aim is not to give you detailed information about specialized disciplines such as physiology or psychology, psychoneuroimmunology or neuroscience. Rather, it is to expand your perspective on who you are and on your relationship to the world, and perhaps even to inspire you to reflect more deeply on and develop greater confidence in your own body and mind, and to know yourself as a wholly integrated thinking, feeling, and socially interacting being. It is hoped that the views and information presented here will help you to develop your own view of why you might undertake to practice meditation regularly, a personal vision within which you can put the healing power of mindfulness to practical use in your own life.
* When patients come to the hospital, each visit generates an “encounter form” in order to ensure payment. From the perspective of participatory medicine, it is important for both medical and ethical reasons that a true encounter takes place, one in which the patient feels that she or he has been seen, met, and heard as a person, and that his or her concerns will be taken seriously and honored by the physician and by the entire health care team, to whatever degree possible. This principle and perspective is becoming more and more the new standard of practice in medicine, as medicine and health care are coming to recognize the unique individuality of human beings and how person-specific biological, psychological, social, and cultural factors can influence the choice of treatment options and the degree of buy-in, participation, and adherence on the part of the patient. It is in this spirit and from this perspective that we introduce the participants in the Stress Reduction Clinic to some of the more prominent and compelling research developments in the fields of neuroscience, psychology, and medicine that may be relevant to their engagement in MBSR, as well as to the new perspective developing within medicine itself, so that they will have a better understanding of what we are asking of them and why it is so important.